Evaluation of safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma.</p><p><b>METHODS</b>From January 2005 to March 2012, 260 patients with esophageal carcinoma received thoracoscopic esophagectomy (TE group), while 322 patients underwent conventional open esophagectomy (OE group). Operative procedures, perioperative complications, reoperation, readmission to intensive care unit (ICU), and perioperative mortality were compared between the two groups.</p><p><b>RESULTS</b>Compared with OE group, TE group possessed less thoracic operative time [(105±30) min vs. (112±41) min, P=0.000], less blood loss [(95±48) ml vs. (107±44) ml, P=0.002], shorter postoperative hospital stay [(14.3±7.5) d vs. (16.9±9.5) d, P=0.000] and more lymph node harvest from thorax [(13.5±5.0) vs. (11.6±4.7), P=0.000]. The total perioperative complication rate was lower in TE group than that of OE group (34.6% vs. 45.0%, P=0.011), as well as perioperative mortality (0.8% vs. 3.4%, P=0.032). Lower rate of readmission to ICU (5.4% vs. 10.6%, P=0.024) was found in the TE group as compared to the OE group, while the reoperation rate was comparable (1.5% vs. 2.5%, P=0.425).</p><p><b>CONCLUSION</b>Thoracoscopic esophagectomy is advantageous than open procedure in terms of surgical safety.</p>

Feasibility and safety of radical mediastinal lymphadenectomy in thoracoscopic esophagectomy for esophageal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of radical mediastinal lymphadenectomy in thoracoscopic esophagectomy for esophageal cancer.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of a cohort of 147 patients with esophageal cancer who underwent thoracoscopic esophagectomy. Seventy-one patients received traditional lymphadenectomy for the periesophageal and subcarinal lymph nodes (traditional dissection group), while 76 patients received radical lymph node dissection for the bilateral recurrent laryngeal nerve lymphatic chains as well as the periesophageal and subcarinal nodes (radical dissection group). The number of retrieved lymph nodes, incidence of node metastasis, the operation time, estimated blood loss, complications, morbidity and mortality were compared between the two groups.</p><p><b>RESULTS</b>Thoracoscopic esophagectomy was completed in all patients with no conversion to thoracotomy. There were no significant differences of operational time and blood loss between the two groups [(89 ± 32) min versus (99 ± 32) min, P = 0.064; (152 ± 108) ml versus (107 ± 82) ml, P = 0.261]. In all patients, the total and average number of retrieved mediastinal nodes were 1644 and 11.2 ± 5.9/case, and the incidence of metastatic lymph nodes was 24.5%. The total and average number of retrieved mediastinal nodes were 999 and 13.6 ± 6.4/case in the radical dissection group, significantly higher than that in the traditional dissection group (645 and 9.1 ± 4.4/case) (P < 0.001). The average number of retrieved nodes and node metastasis rate in the radical dissection group were significantly higher than in the traditional dissection group (13.1 ± 6.4 versus 9.1 ± 4.4, P < 0.001; 35.5% versus 12.7%, P < 0.05). In the total group of 147 cases, the metastasis rates of periesophageal, subcarinal nodes and nodes along the recurrent laryngeal nerve lymphatic chains were 19.7%, 3.4% and 17.1%, respectively. There was thoracic lymph node metastasis in 27 cases with a metastasis rate of 35.5% in the radical dissection group, significantly higher than that in 9 cases and 12.7% in the traditional dissection group (P > 0.001). In the 1644 retrieved thoracic lymph nodes, there were 90 positive metastatic lymph nodes (metastasis ratio 5.5%). Among the 1644 lymph nodes, the metastasis ratio of periesophageal lymph nodes was 6.5%, subcarinal lymph modes 2.4% and the recurrent laryngeal nerve chain lymph nodes 7.5%. Among the 147 cases, complications occurred in 60 cases, with an overall morbidity rate of 40.8%. There were no significant differences of the incidence rates of overall complications, pulmonary complications and recurrent laryngeal nerve injury between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Thoracoscopic esophagectomy with radical mediastinal lymphadenectomy is technically Safe and feasible.</p>

Comparison of thoracoscopic esophagectomy in decubitus position with prone position / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the safety and efficacy between two different surgical approaches for thoracoscopic esophagectomy including left lateral decubitus position and prone position.</p><p><b>METHODS</b>From January 2008 to December 2009, 88 patients who underwent thoracoscopic esophagectomy were enrolled in this study. Among them, 52 patients were placed in decubitus position and 36 patients were placed in prone position.</p><p><b>RESULTS</b>No conversion to thoracotomy occurred in either group. The operative time was shorter in the prone group than that in the decubitus group (70 ± 20 min vs. 82 ± 17 min, P<0.01). Blood loss during operation was less in the prone group(100 ± 52 ml vs. 139 ± 54 ml, P<0.01). More lymph nodes were harvested from chest in the prone group(12.2 ± 6.2 vs. 8.6 ± 4.3, P<0.01). There was no significant difference between the two groups in morbidity.</p><p><b>CONCLUSION</b>Thoracoscopic esophagectomy in prone position is associated with better exposure of surgical filed, shorter operative time, less blood loss, and more extensive lymph node dissection as compared to decubitus position.</p>

Comparison of retrosternal and posterior mediastinal gastric tube reconstruction after three-phase esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the outcome between retrosternal and posterior mediastinal gastric tube reconstruction after three-phase esophagectomy.</p><p><b>METHODS</b>A total of 107 patients who underwent three-phase esophagectomy between July 2005 and May 2009 were enrolled in this study.</p><p><b>RESULTS</b>There were 78 men and 29 women. Median age was 62.1 years. The tumor located at upper segment in 20 cases, middle segment in 69 cases and lower segment in 18 cases. There were 55 patients in the posterior mediastinal group and 52 in the retrosternal group. There were no significant differences between two groups in operation time, intraoperative blood loss, duration of chest tube. Hospital stay of retrosternal group was longer as compared to posterior mediastinal group. No death occurred in both groups. Anastomotic leakage occurred more frequently in retrosternal group than that in posterior mediastinal group (26.9% vs 5.5%). Postoperative pneumonia, atelectasis and arrhythmia were not significantly different between two groups.</p><p><b>CONCLUSIONS</b>After three-phase esophagectomy, both retrosternal and posterior mediastinal gastric tube reconstruction can be performed easily and safely. Morbidity of anastomotic leakage is higher in retrosternal reconstruction. Individualized gastric tube reconstruction should be considered.</p>

Video-assisted thoracoscopic esophagectomy in esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of video-assisted thoracoscopic (VATS) esophagectomy in the treatment of esophageal cancer.</p><p><b>METHODS</b>From June 2004 to October 2007, video-assisted thoracoscopic esophagectomy was performed in 36 patients, including 29 men and 7 women with median age of 58.9 years old. The cancer located at upper segment in 5 cases, middle 25 cases and lower 6 cases. VATS approach was used to mobilize the intrathoracic esophagus and stomach was mobilized by open approach. Esophagogastric anastomosis was performed in the left neck.</p><p><b>RESULTS</b>The mean operative time was 250 minutes (190-330 min) and average time of VATS was 70 minutes. The mean hospital stay was 8.7 days. Mean lymph node harvest was 14.3 nodes. Post-operative complications occurred in 11 patients(30.6%), but no perioperative death occurred.</p><p><b>CONCLUSION</b>Video-assisted thoracoscopic esophagectomy is technically feasible and safe with lower morbidity and shorter hospital stay as compared to open procedure, and may replace the open esophagectomy in selected patients.</p>

Diagnosis and treatment of esophageal leiomyoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of diagnosis and treatment of esophageal leiomyoma.</p><p><b>METHODS</b>Clinical data of 52 patients with esophageal leiomyoma were analyzed from 1993 to 2002.</p><p><b>RESULTS</b>About 54% patients in this group had difficulty of food intake. The diagnostic accuracy of gastrointestinal barium meal series, computed tomography, gastric endoscope and endoscopic ultrasonography (EUS) for esophageal leiomyoma was 64% 44% 27% and 90% respectively. All patients received operation, resection of esophageal leiomyoma by videothoracoscopy (VAS) and endoscope were performed in 6, 9 patients respectively. The remaining 37 patients received regular open operation,in whom 32 cases received enucleation of esophageal leiomyoma, 5 cases received partial esophageal resection and esophageal-gastric anastomosis. No serious complications occurred except only one case needed operation again because of bleeding.</p><p><b>CONCLUSION</b>EUS is an effective method for diagnosing esophageal leiomyoma. VAS and endoscopic treatment should be considered for suitable cases in order to reduce the trauma.</p>